Service · Critical care

Dialysis for the sickest patients.

SLEDD and CRRT for ICU patients with shock, sepsis, or unstable haemodynamics — slow, continuous, gentle. The dialysis your body can tolerate when standard HD would crash you.

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What it is

When standard dialysis isn't safe.

In ICU, the patients who need dialysis the most are often the ones who can't tolerate it. Septic shock, low blood pressure, cardiac failure, multi-organ dysfunction — a four-hour conventional dialysis session would collapse them.

SLEDD (Slow Low-Efficiency Daily Dialysis) and CRRT (Continuous Renal Replacement Therapy) are the answer. They remove fluid and toxins slowly, over 8–24 hours, at rates the failing heart and circulation can handle.

CRRT runs continuously — 24 hours, sometimes for days. SLEDD bridges the gap: 8–12 hours of slow dialysis daily. Both require trained nephrology and ICU teams running them together — which is exactly how we do it.

"If a patient in shock can't tolerate dialysis, the answer is not to stop dialysis. It's to change the dialysis."

How we do it differently

Slow, continuous, hemodynamically gentle.

Standard dialysis pulls hard. CRRT and SLEDD pull gently. In ICU, gentle saves lives.

CRRT

24-hour continuous therapy

For unstable ICU patients. CVVH, CVVHD, or CVVHDF run continuously through a tunnelled or temporary line. Fluid removal targets set hourly.

SLEDD

8–12 hour daily sessions

A middle ground between conventional HD and CRRT. Slower flows, longer sessions, much better tolerated by shocky patients.

Nephrology + ICU together

Two specialties, one prescription

Every CRRT and SLEDD prescription is co-written by the nephrologist and intensivist. Anticoagulation, electrolytes, and fluid balance reviewed jointly.

Citrate or heparin

Anticoagulation matched to bleed risk

Citrate anticoagulation for high bleed risk patients — the safest modern protocol. Standard heparin for stable ones. Choice made per patient.

What to expect

From referral to first run.

ICU dialysis is rarely planned. We're built to start within hours.

ICU referral & assessment

Nephrology consults at the bedside. Indications confirmed: hyperkalemia, acidosis, fluid overload, uraemia, or specific intoxications. Modality chosen.

Access placement

Temporary or tunnelled central line placed under ultrasound. If access is already in place and adequate, we use it.

Continuous or daily prescription

CRRT or SLEDD prescription written: flows, fluid removal target, anticoagulation, replacement fluid composition. Bedside set-up.

Joint review, daily titration

Nephrology and ICU teams review labs, fluid balance, and haemodynamics every shift. Prescription titrated. Transition to standard HD or recovery monitored.

Frequently asked

Questions worth asking.

Before you start a treatment anywhere — these are the questions to ask. We've answered ours.

Who needs CRRT or SLEDD?

Patients in ICU with acute kidney injury who are too unstable for standard dialysis: septic shock, cardiac failure, multi-organ failure, severe brain injury. Also patients with severe poisoning, certain liver failures, and some heart-lung indications.

How long does a patient stay on CRRT?

Anywhere from 24 hours to 7–10 days, depending on how quickly haemodynamics improve. Most patients transition to SLEDD, then standard HD, then off dialysis entirely as kidneys recover.

Is CRRT only available at certain centres?

Yes — CRRT requires specialised machines, trained ICU nurses, and continuous nephrology cover. We deliver it at partner ICUs where we are embedded with the critical care team.

Is it more expensive than regular dialysis?

Per-hour, yes. The consumables and continuous monitoring are more intensive. But the alternative — cardiac arrest during conventional dialysis — is not a choice. We discuss costs honestly before starting.

Talk to a nephrologist.

Whether you're starting dialysis, switching centres, or just want a second opinion — one conversation tells you everything you need.

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